The use and value of procalcitonin in solid organ transplantation

Abstract

Procalcitonin (PCT) has been increasingly used as a biomarker of bacterial infection and as a tool to guide antimicrobial therapy, especially in lower respiratory tract and bloodstream infections. Despite its increased use, data in patients with solid organ transplants are limited. Even without the presence of infection, PCT increases as a result of surgical procedures during transplantation, implantation of devices, and use of induction immunosuppressive therapy. The risk of infection is also higher in solid organ transplant recipients when compared to the general population. Monitoring PCT in the early post-transplant period seems to be a promising method for early detection of infectious complications. It has been shown that elevated PCT levels after one wk of transplantation are correlated with infectious complications. PCT may be a useful adjunctive biomarker that may improve early identification and guide appropriate treatment of infection or rejection, with the potential to further improve clinical outcomes. The use of serial PCT measurements may be more reliable than single values. It is important to recognize which factors may lead to PCT increases in the post-transplantation period, which in turn will help understand the kinetics and utility of this biomarker in this important patient population.

Pneumonia in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice

“…86 Several studies have evaluated the utility of procalcitonin measurement for detecting and differentiating bacterial infection from other solid organ transplant complications, 87-94 reviewed in. 95 Importantly, procalcitonin levels are impacted by surgery as well as by ATG administration which may decrease the utility of this assay in first week post-transplant. 95 (Figure 1).…”

“…95 Importantly, procalcitonin levels are impacted by surgery as well as by ATG administration which may decrease the utility of this assay in first week post-transplant. 95 (Figure 1).…”

Pretransplant serum procalcitonin level for prediction of early post‐transplant sepsis in living donor liver transplantation

“…In a post‐transplant setting, studies have shown the benefit of PCT for diagnosis of bacterial infection and differentiation from acute cellular rejection . However, the influences of the length of surgery and immunosuppression therapy have not been sufficiently examined . In this study, we focused on the relationship between post‐transplant sepsis and pretransplant PCT that was unaffected by surgical factors or post‐transplant management.…”

“…Serum procalcitonin (PCT) is used as a biomarker of bacterial infection and sepsis in a number of areas, and may be useful for early detection of infection and differentiation from non‐infectious complications after LT . However, it is difficult to exclude the effects of highly invasive surgical procedures and post‐transplant immunosuppression therapy on the serum PCT level …”

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“…Therefore, it can be used to guide determination of the length of the antimicrobial therapy and to assess the response to treatment. 13 Serial measurement of serum procalcitonin levels can help detect early bacterial infections. In a retrospective study invo lving kidney transplant recipients, patients with serum CRP levels 118 > 10 mg/dL or procalcitonin levels > 8.8 ng/mL have been reported to have worse prognosis.…”